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Cohen N, Nasra LA, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Pain and anxiety management with virtual reality for office hysteroscopy: systemic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1127-1134. [PMID: 37917158 DOI: 10.1007/s00404-023-07261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Office hysteroscopy (OH) is a commonly performed procedure, although it might be associated with some degree of pain and anxiety. Our aim was to determine the effects of virtual reality on pain and anxiety levels felt by patients undergoing OH. METHODS MEDLINE, Embase, Google Scholar, Cochrane Library, clinicaltrials.gov, ProQuest, Grey literature, and manual searching of references within studies found in the initial search were systematically searched using the terms 'Virtual Reality' and 'Hysteroscopy' without time or language limitations. The review considered all studies assessing the impact of virtual reality (VR) over OH outcomes, and prospective randomized trials were included in the meta-analysis. Retrospective and case - control studies were excluded from the meta-analysis. RESULTS We identified 17 studies, of which four randomized controlled studies were included in the meta-analysis (327 participants, 168 in the VR group and 159 in the control group). On a 0-10 scale, pain sensation and maximal pain sensation during the operation were not statistically different between study and control groups (relative risk (RR) = -0.64, 95% C.I (-1.57)0.29) and (RR = -0.93, 95% C.I (-3.33) - 1.47), respectively. Anxiety measurement was statistically lower in the study group (RR = -1.73, 95% C.I (-2.79) - ( -0.67)). CONCLUSIONS The available data suggest that VR techniques do not decrease the pain sensation during OH however, they do contribute to a reduction in the anxiety levels experienced by patients. PROSPERO registration number CRD42023432819.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel.
| | - Lelia Abu Nasra
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
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Baradwan S, Alshahrani MS, AlSghan R, Alyafi M, Elsayed RE, Abdel-Hakam FA, Moustafa AA, Hussien AE, Yahia OS, Shama AA, Magdy AA, Abdelhakim AM, Badran H. The effect of virtual reality on pain and anxiety management during outpatient hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2024; 309:1267-1280. [PMID: 38165441 DOI: 10.1007/s00404-023-07319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Our study aimed to evaluate the effectiveness of virtual reality (VR) intervention for pain and anxiety relief during outpatient hysteroscopy. METHODS Various databases were searched for available clinical trials from inception until June 2023. We selected randomized controlled trials (RCTs) that compared virtual reality intervention versus standard care among women undergoing outpatient hysteroscopy. We used Revman software to perform our meta-analysis. The primary outcome was the pain score during the procedure. The secondary outcomes were anxiety during the procedure and pain post-procedure. The Visual Analog Scale (VAS) was used to assess pain and anxiety. RESULTS Six RCTs were retrieved, involving a total of 457 patients. Virtual reality was associated with a significant reduction in pain score during the procedure in comparison with the control group (MD = - 1.43, 95% CI [- 1.69, - 1.16], p < 0.001). In addition, there was a significant decrease in anxiety during the procedure among the virtual reality group compared to the control group (p = 0.01). The pain score post-procedure significantly decreased within the virtual reality group (MD = - 1.52, 95% CI [- 1.78, - 1.26], p < 0.001). CONCLUSIONS Virtual reality technology is a simple, feasible, and effective intervention for reducing pain and anxiety during outpatient hysteroscopy. More trials are required to confirm our findings.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, AlKharj, Saudi Arabia
| | - Mohammad Alyafi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rasha Ezzat Elsayed
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Faiza Ahmed Abdel-Hakam
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Ayman Esmail Hussien
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - Othman Saadeldien Yahia
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Abdelaziz Shama
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Ahmed Magdy
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Haitham Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Evans I, Reisel D, Jones A, Bajrami A, Nijjar S, Solangon SA, Arora R, Redl E, Schreiberhuber L, Ishaq-Parveen I, Rothärmel J, Herzog C, Jurkovic D, Widschwendter M. Performance of the WID-qEC test versus sonography to detect uterine cancers in women with abnormal uterine bleeding (EPI-SURE): a prospective, consecutive observational cohort study in the UK. Lancet Oncol 2023; 24:1375-1386. [PMID: 37944542 DOI: 10.1016/s1470-2045(23)00466-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND To detect uterine cancer, simpler and more specific index tests are needed to triage women with abnormal uterine bleeding to a reference histology test. We aimed to compare the performance of conventional index imaging tests with the novel WID-qEC DNA methylation test in terms of detecting the presence or absence of uterine cancers in women with abnormal uterine bleeding. METHODS EPI-SURE was a prospective, observational study that invited all women aged 45 years and older with abnormal uterine bleeding attending a tertiary gynaecological diagnostic referral centre at University College London Hospital (London, UK) to participate. Women meeting these inclusion criteria who consented to participate were included. Pregnant women and those with previous hysterectomy were excluded. A cervicovaginal sample for the WID-qEC test was obtained before standard assessment using index imaging tests (ie, ultrasound) and, where applicable, reference histology (ie, biopsy, hysteroscopy, or both) was performed. Technicians performing the WID-qEC test were masked to the final clinical outcome. The result of the WID-qEC test is defined as the sum of the percentage of fully methylated reference (ΣPMR) of the ZSCAN12 and GYPC regions. Patients were followed until diagnostic resolution or until June 12, 2023. The primary outcome was to assess the real-world performance of the WID-qEC test in comparison with ultrasound with regard to the area under the receiver-operating-characteristic curve (AUC), sensitivity, specificity, and positive and negative predictive values. EPI-SURE is registered with ISRCTN (16815568). FINDINGS From June 1, 2022, to Nov 24, 2022, 474 women were deemed eligible to participate. 74 did not accept the invitation to participate, and one woman withdrew after providing consent. 399 women were included in the primary analysis cohort. Based on 603 index imaging tests, 186 (47%) women were recommended for a reference histology test (ie, biopsy, hysteroscopy, or both). 12 women were diagnosed with cancer, 375 were not diagnosed with cancer, and 12 had inconclusive clinical outcomes and were considered study dropouts. 198 reference histology test procedures detected nine cases of cancer and missed two; one further cancer was directly diagnosed at hysterectomy without a previous reference test. The AUC for detection of uterine cancer based on endometrial thickness in mm was 87·2% (95% CI 71·1-100·0) versus 94·3% (84·7-100·0) based on WID-qEC (p=0·48). Endometrial thickness assessment on ultrasound scan was possible in 379 (95%) of the 399 women and a prespecified cut-off of 4·5 mm or more showed a sensitivity of 90·9% (95% CI 62·3-98·4), a specificity of 79·1% (74·5-82·9), a positive predictive value of 11·8% (6·5-20·3), and a negative predictive value of 99·6% (98·0-99·9). The WID-qEC test was possible in 390 (98%) of the 399 patients with a sensitivity of 90·9% (95% CI 62·3-98·4), a specificity of 92·1% (88·9-94·4), a positive predictive value of 25·6% (14·6-41·1), and a negative predictive value of 99·7% (98·3-99·9), when the prespecified threshold of 0·03 ΣPMR or more was applied. When a higher threshold (≥0·3 ΣPMR) was applied the specificity increased to 97·3% (95% CI 95·1-98·5) without a change in sensitivity. INTERPRETATION The WID-qEC test delivers fast results and shows improved performance compared with a combination of imaging index tests. Triage of women with abnormal uterine bleeding using the WID-qEC test could reduce the number of women requiring histological assessments for identification of potential malignancy and specifically reduce the false positive rate. FUNDING The Eve Appeal, Land Tirol, and the European Research Council under the European Union's Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- Iona Evans
- Department of Women's Cancer, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Daniel Reisel
- Department of Women's Cancer, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Allison Jones
- Department of Women's Cancer, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Alba Bajrami
- Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Simrit Nijjar
- Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Sarah Annie Solangon
- Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elisa Redl
- European Translational Oncology Prevention and Screening Institute, University of Innsbruck, Tirol, Austria; Research Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Lena Schreiberhuber
- European Translational Oncology Prevention and Screening Institute, University of Innsbruck, Tirol, Austria; Research Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Isma Ishaq-Parveen
- European Translational Oncology Prevention and Screening Institute, University of Innsbruck, Tirol, Austria
| | - Julia Rothärmel
- European Translational Oncology Prevention and Screening Institute, University of Innsbruck, Tirol, Austria
| | - Chiara Herzog
- European Translational Oncology Prevention and Screening Institute, University of Innsbruck, Tirol, Austria; Research Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Davor Jurkovic
- Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Martin Widschwendter
- Department of Women's Cancer, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK; European Translational Oncology Prevention and Screening Institute, University of Innsbruck, Tirol, Austria; Research Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Gynaecology and Obstetrics, Tirol Kliniken, Tirol, Austria.
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Sewell T, Fung Y, Al-Kufaishi A, Clifford K, Quinn S. Does virtual reality technology reduce pain and anxiety during outpatient hysteroscopy? A randomised controlled trial. BJOG 2023; 130:1466-1472. [PMID: 37218438 DOI: 10.1111/1471-0528.17550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of virtual reality technology in reducing pain and anxiety during outpatient hysteroscopy. DESIGN A prospective randomised controlled trial. SETTING A London University Teaching Hospital. POPULATION Women aged 18-70 years undergoing outpatient hysteroscopy procedures. METHODS An unblinded randomised controlled trial was performed between March and October 2022 comparing standard outpatient hysteroscopy care with standard care with the addition of a virtual reality headset playing a virtual reality immersive scenario as a distraction technique. MAIN OUTCOME MEASURES Pain and anxiety numeric rating scores (NRS) from 0 to 11. RESULTS Eighty-three participants were randomly allocated to the control (n = 42) and virtual reality groups (n = 41). The virtual reality group experienced significantly less anxiety during the procedure than the control group (mean NRS 3.29 versus 4.73, mean difference 1.50; 95% confidence interval [CI] 0.12-2.88; P = 0.03). There was no difference in reported average pain (mean NRS 3.73. versus 4.24, mean difference 0.51; 95% CI -1.76 to 0.64; p = 0.41) or maximum pain scores (mean NRS 5.32 versus 5.07, mean difference 0.25; 95% CI -1.05 to 1.55; P = 0.71). CONCLUSIONS The use of virtual reality technology as an adjunct to standard care can reduce patient-reported anxiety but not pain during outpatient hysteroscopy procedures. Continued improvements in the technology and the development of increasingly immersive environments may continue to increase the potential to improve the patient experience in this setting.
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Affiliation(s)
- Thomas Sewell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Yinka Fung
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Asmaa Al-Kufaishi
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Katy Clifford
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Stephen Quinn
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
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Huang L, Yu Q, Zhu Z, Huang P, Ding X, Ma X, Chen Y, Su D. The Current Situation of Anaesthesia for Hysteroscopy in Mainland China: A National Survey. J Pers Med 2023; 13:1436. [PMID: 37888047 PMCID: PMC10608545 DOI: 10.3390/jpm13101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose: The need for anaesthesia or analgesia for performing hysteroscopy remains debatable. This study aimed to conduct an overview of the situation of anaesthesia for hysteroscopy in mainland China. Methods: Two questionnaires were separately designed for anaesthesiologists and gynaecologists and distributed to every medical institution that performed hysteroscopic procedures on patients with infertility in mainland China. Electronic questionnaires were distributed via WeChat, and data on anaesthesia regimen, monitoring parameters, procedure number, and other information were collected. Results: Reproductive technology is conducted by 536 institutions in mainland China. The survey received 491 responses from anaesthetists (91.6%) and 436 from gynaecologists (81.3%). In 2021, 552,225 hysteroscopies were conducted in 268 medical centres. The average percentage of hysteroscopy under anaesthesia is 63.8% in 2021, wherein 47.3% of institutions have an anaesthesia percentage of >75%. Propofol and opioid analgesics, such as fentanyl and sufentanil, were the most commonly used intravenous anaesthetics. All sedations were performed by anaesthesiologists. Monitoring parameters included pulse oxygen saturation (98.9%), electrocardiogram (91.6%) and noninvasive blood pressure (91.3%). An anaesthesiologist-to-operating room ratio of <1 was observed in 31.3% of medical institutions. Surprisingly, 52.4% of medical institutions performing hysteroscopy had no postanaesthesia care unit (PACU). Most institutions with PACU were equipped with independent oxygen sources, suction and monitors. Both rigid and flexible hysteroscopes (rigid hysteroscope, 45.1%; flexible hysteroscope, 4.5%; both types, 50.4%) were used, and the hysteroscopic diameter was ≤5 mm in 60.3% of medical centres. Conclusions: China performs a large number of hysteroscopies, and sedation is the most frequently used anesthesia regimen. However, issues such as inadequate emergency support devices, insufficient personnel and weak resuscitation management after anaesthesia, have been observed.
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Affiliation(s)
| | | | | | | | | | | | | | - Diansan Su
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China; (L.H.); (Q.Y.); (Z.Z.); (P.H.); (X.D.); (X.M.); (Y.C.)
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Çallıoğlu N, Kanza Gül D, Özer Aslan İ, Fendal Tunca A, Başlı Kasım K, Akay B, Uysal E, Ekin M. The effect of informing the patient about the procedure with video imaging before office hysteroscopy on pain. J Obstet Gynaecol Res 2023; 49:2387-2392. [PMID: 37462062 DOI: 10.1111/jog.15738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/27/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To evaluate the effect of informing patients undergoing diagnostic office hysteroscopy via a video 24 h before the procedure and determine the changes in pain scores, channel transit time, the degree of difficulty of the procedure, and physiological parameters. DESIGN Single-blind randomized controlled trial. SETTING The study was conducted between September 1, 2021 and April 1, 2022 at the University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital. PARTICIPANTS A total of 134 patients aged 18-65 years who needed diagnostic office hysteroscopy. INTERVENTIONS Participants were randomized into two groups, the standard information group (Group 1: controls), and the video information + standard information group (Group 2). After office hysteroscopy, a visual analog scale (VAS) and Likert scale were used to assess pain and the degree of difficulty of the procedure, respectively. Physiological parameters were evaluated before and after the procedure. MAIN OUTCOME MEASURE To determine the effect of video-based multimedia information administered 24 h before office hysteroscopy on post-procedure pain. RESULTS The mean VAS score of the group that watched the training video (3.02 ± 1.88) was significantly lower than the control group (4.72 ± 2.54) who did not watch the training video (p < 0.001). The mean cervical channel transit time in seconds (sec) during the procedure was found to be significantly higher in the control group (21.57 ± 15.10 s) than in the video-watching group (p = 0.011). There was no significant difference between the groups in terms of physiological parameters and the degree of ease of the procedure. CONCLUSION Our study has shown that informing patients in a pre-procedure video is an effective approach that shortens the duration of the channel transit time and reduces pain.
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Affiliation(s)
- Nihal Çallıoğlu
- Department of Obstetrics and Gynecology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Derya Kanza Gül
- Medipol University School of Medicine Health, Istanbul, Turkey
| | - İlke Özer Aslan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Aysun Fendal Tunca
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kardelen Başlı Kasım
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Burcu Akay
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Elif Uysal
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Manouchehrian N, Pilehvari S, Rahimi-Bashar F, Esna-Ashari F, Mohammadi S. Comparison of the effects of spinal anesthesia, paracervical block and general anesthesia on pain, nausea and vomiting, and analgesic requirements in diagnostic hysteroscopy: A non-randomized clinical trial. Front Med (Lausanne) 2023; 10:1089497. [PMID: 36936226 PMCID: PMC10016381 DOI: 10.3389/fmed.2023.1089497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/18/2023] [Indexed: 03/05/2023] Open
Abstract
Background The aim of this study was to compare the effect of spinal anesthesia (SPA), paracervical block (PB), and general anesthesia (GA), on pain, the frequency of nausea and vomiting and analgesic requirements in diagnostic hysteroscopy. Methods This single-center, non-randomized, parallel-group, clinical trial was conducted on 66 diagnostic hysteroscopy candidates who were selected by convenience sampling at Fatemieh Hospital, in Hamadan, Iran, in 2021. Results The mean pain score during recovery and the need for analgesic injections was found to be significantly higher in the GA group compared to that in the SPA group (pain: 3.77 ± 2.25 vs. 0.10 ± 0.30, P < 0.001), (analgesic: 50 vs. 0%, P < 0.001) and PB group (pain: 3.77 ± 2.25 vs. 0.90 ± 1.37, P < 0.001), (analgesic 50 vs. 10%, P < 0.001), respectively. However, no statistically significant difference was observed between the mean pain score between SPA and PB groups (0.10 ± 0.30 vs. 0.90 ± 1.3, P = 0.661). In addition, there were no significant differences between groups on nausea/vomiting after operation (P = 0.382). In adjusted regression analysis (adjusting for age, weight, gravid, abortion, and cause of hysteroscopy), the odds ratio (OR) of pain score during recovery was increased in PB (OR: 4.471, 95% CI: 1.527-6.156, P = 0.018) and GA (OR: 8.406, 95% CI: 2.421-9.195, P = 0.001) groups compared with the SPA group. However, in adjusting based on times of surgery duration, anesthesia duration, recovery and return of motor function, the ORs of pain score between groups was not statistically significant. Conclusion Despite reduced pain during recovery in patients receiving SPA, duration of anesthesia, recovery period, and return of motor function were significantly prolonged compared to those receiving PB or GA. It seems that PB with less recovery time and faster return of motor function than SPA and also mild pain during recovery compared to GA can be a good option for hysteroscopy. Clinical trial registration http://www.irct.ir, identifier IRCT20120915010841N26.
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Affiliation(s)
- Nahid Manouchehrian
- Department of Anesthesiology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Shamim Pilehvari
- Department of Gynecology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamedan, Iran
| | | | - Farzaneh Esna-Ashari
- Department of Community Medicine, Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamedan, Iran
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8
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Tancman S, HaCohen N, Lazarus G, Solt I, Sagi-Dain L. Silent voices that must be heard - women's perceptions of gynecologic examinations. J Psychosom Obstet Gynaecol 2022; 43:190-197. [PMID: 33416005 DOI: 10.1080/0167482x.2020.1864727] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To analyze the perception of gynecologic examination from the patients' point of view. MATERIALS AND METHODS This anonymous electronic cross-sectional survey aimed to evaluate the subjective experiences of women during gynecologic examinations (levels of pain, embarrassment and trauma), the manner the examination was conducted, and women's suggestions for improving their experience. RESULTS Overall, 6,508 women answered the survey. The examination was considered an embarrassing event by 47%, painful by 35% and traumatic by 19%. Importantly, only 43% of the respondents stated they would notify the gynecologist in case of physical discomfort or pain during the examination. The quality of physician-to-patient communication was rated as the most important aspect of gynecologic examination, and showed a significant association with the general quality of the experience (levels of pain, embarrassment, and trauma). Matters relating to women's privacy during gynecologic examination were also considered important. An option for a companion was rated as important by 64% of the respondents. Significant differences with large effect-sizes were found between the respondents' preferences and their reports of the observed situation. CONCLUSION The findings highlight the need for establishing guidelines for gynecologic examinations, according to a patient-centered care approach. This study constitutes a first discourse on the subject of gynecologic examinations in Israel in order to provide an overview and initial insights, serving as a starting point for further specific and more in-depth research.
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Affiliation(s)
- Sara Tancman
- The Briah Foundation for Women's Health, Tel Aviv, Israel
| | - Nehama HaCohen
- The Briah Foundation for Women's Health, Tel Aviv, Israel.,The Interdisciplinary Doctoral Program in Psychoanalysis, Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Gal Lazarus
- Psychology Department, Bar-Ilan University, Ramat-Gan, Israel
| | - Ido Solt
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Affiliated to the Technion Faculty of Medicine, Haifa, Israel
| | - Lena Sagi-Dain
- Department of Obstetrics and Gynecology, Genetics Institute, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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9
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Marchand GJ, Kurdi W, Sainz K, Maarouf H, Ware K, Masoud AT, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Ulibarri H, Parise J, Arroyo A, Chen D, Pierson M, Rafie R, Shareef MA. Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis. J Turk Ger Gynecol Assoc 2022; 23:51-57. [PMID: 34866373 PMCID: PMC8907440 DOI: 10.4274/jtgga.galenos.2021.2021-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We conducted a systematic review and meta-analysis of relevant clinical trials from full-text, scientific journal archives to assess the efficacy of hyoscine for the management of pain during in-office hysteroscopy (OH) procedures. Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS and the Web of Science were searched for all clinical trials that matched our search criteria. A full assessment of bias was made using the Cochrane Group tool-set. The following outcomes were included: visual analogue scale (VAS) score for postoperative pain, postoperative need for analgesia, and procedure time. In the case of homogeneous data, the analysis was performed using a fixed effects system, and the random effects system was used with heterogeneous data. Inclusion criteria included only randomized clinical trials, and interventions that included patients receiving hyoscine-N-Butyl Bromide during OH, regardless of dose or mode of administration, and compared this with placebo. Three clinical trials were included. The actual mean difference (MD) of the VAS pain score showed no significant difference between hyoscine or placebo [MD: -0.28 (-1.08, 0.52), (p=0.49)]. For postoperative analgesia, the overall MD showed no significant difference between hyoscine or placebo [MD: 0.43 (0.16, 1.14), (p=0.09)]. For procedure time, the combined effect estimate failed to show any significant difference between hyoscine and placebo [MD: -0.66 (-2.77, 1.44) (p=0.54)]. Contrary to previously published data, our meta-analysis using the latest available RCTs fails to show hyoscine as being effective in reducing pain or the need for other forms of anesthesia in OH.
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Affiliation(s)
- Greg J. Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Wesam Kurdi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hiba Maarouf
- REProVita Fertility Center, Recklinghausen, Germany
| | - Kelly Ware
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Ahmed Taher Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Nicolas Calteux
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hollie Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Julia Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Amanda Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Diana Chen
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Maria Pierson
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Rasa Rafie
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States of America
| | - Mohammad Abrar Shareef
- Department of Internal Medicine, Sebasticook Valley Hospital, Pittsfield, ME, United States of America
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Opioid Dispensing After Hysteroscopy in the United States. Obstet Gynecol 2021; 138:888-890. [PMID: 34735387 DOI: 10.1097/aog.0000000000004591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
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Ribeiro CM, Brito LGO, Benetti-Pinto CL, Teixeira JC, Yela DA. Is Diagnostic Hysteroscopy Safe for the Investigation of Type II Endometrial Cancer? A Retrospective Cohort Analysis. J Minim Invasive Gynecol 2021; 28:1536-1543. [PMID: 33444791 DOI: 10.1016/j.jmig.2021.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE Although hysteroscopy (HSC) can be used for assessing the uterine cavity in women with suspected endometrial cancer (EC), it remains controversial as a procedure because it can potentially enhance the metastatic spread of cancer cells. Moreover, it is important to assess this hypothesis for type II EC, a more aggressive phenotype that usually presents with endometrial atrophy and has worse prognosis. Thus, we aimed to assess the prevalence of positive peritoneal cytology result in women with type II EC who underwent HSC as a diagnostic tool and to determine the factors associated with patient relapse/survival. DESIGN Retrospective cohort analysis (2002-2017). SETTING Tertiary, academic hospital. PATIENTS One hundred twenty-seven women with type II EC. INTERVENTIONS Diagnostic HSC (HSC) (n = 43) or dilation/curettage (D&C) (n = 84). MEASUREMENTS AND MAIN RESULTS Primary end point was the frequency of positive peritoneal cytology result. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis with hazard ratio (HR) and 95% confidence intervals (CIs) were calculated to assess the factors related with the disease-free survival (DFS) and the disease-specific survival (DSS). Advanced cancer stage and greater vascular invasion appeared more frequently in the D&C group (p = .008 and p = .04, respectively). Positive peritoneal cytology result was present in 2 of 43 (4.6%) women following HSC and in 9 of 84 (10.7%) following D&C (p = .22). DFS and DSS curves did not statistically differ between the groups. Multivariate analysis for DFS revealed that advanced cancer stage (III and IV) (HR = 4.67; 95% CI, 2.34-9.34; p <.001) and advanced age (HR = 1.08; 95% CI, 1.04-1.13]; p <.001) were the factors associated with relapse. For DSS, advanced age (HR = 1.08; 95% CI, 1.05-1.12; p <.001), cancer stage III/IV (HR = 3.95; 95% CI, 2.18-7.15; p <.001), and vascular invasion (HR = 2.47; 95% CI, 1.34-4.54; p = .004) increased the risk of mortality. CONCLUSION Diagnostic HSC did not increase the rate of positive peritoneal cytology result at the time of surgical staging in this cohort of women with type II EC and is probably as safe as D&C.
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Affiliation(s)
- Carolina Machado Ribeiro
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ribeiro, Brito, Benetti-Pinto, and Yela), Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Luiz Gustavo Oliveira Brito
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ribeiro, Brito, Benetti-Pinto, and Yela), Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Cristina Laguna Benetti-Pinto
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ribeiro, Brito, Benetti-Pinto, and Yela), Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Júlio César Teixeira
- Divison of Gynecologic Oncology (Dr. Teixeira), Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Daniela Angerame Yela
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ribeiro, Brito, Benetti-Pinto, and Yela), Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
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Louwerse MD, Hehenkamp WJK, van Kesteren PJM, Lissenberg BI, Brölmann HAM, Huirne JAF. Electronic Continuous Pain Measurement vs Verbal Rating Scale in gynaecology: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 256:263-269. [PMID: 33254087 DOI: 10.1016/j.ejogrb.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare pain measured with a new electronic device - the Continuous Pain Score Meter (CPSM) - and the Verbal Rating Scale (VRS) during gynaecological procedures in an outpatient setting, and to correlate these outcomes with baseline anxiety and patient (in)tolerance to the procedure. STUDY DESIGN This prospective cohort study was undertaken in two centres: a university hospital and a large teaching hospital in The Netherlands. Patients undergoing an outpatient hysteroscopy, colposcopy or ovum pick-up procedure for in-vitro fertilization in one of the two participating hospitals with availability of the CPSM were included. Pain was measured by both the CPSM and the VRS. Patient tolerance to the procedure was reported. Various outcomes of the CPSM were compared with those of the VRS and related to baseline anxiety scores. RESULTS Ninety-one of 108 included patients (84 %) used the CPSM correctly during the procedure, and it was possible to analyse the CPSM scores for 87 women (81 %). The CPSM scores were all linearly related to the VRS. The peak pain score on the CPSM (CPSM-PPS) had the strongest correlation with the VRS score for all three procedures. Higher CPSM-PPS was related to patient (in)tolerance to the procedure (p = 0.03-0.002). Anxiety at baseline was not correlated with pain perception, except for VRS during colposcopy (r = 0.39, p = 0.016). CONCLUSION The majority of patients were able to use the CPSM correctly, resulting in detailed information on pain perception for each individual pain stimulus during three outpatient gynaecological procedures. The CPSM-PPS had the strongest correlation with the VRS score and patient (in)tolerance to the procedure.
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Affiliation(s)
- Marjoleine D Louwerse
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Birgit I Lissenberg
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
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Vitale SG, Alonso Pacheco L, Haimovich S, Riemma G, De Angelis MC, Carugno J, Lasmar RB, Di Spiezio Sardo A. Pain management for in-office hysteroscopy. A practical decalogue for the operator. J Gynecol Obstet Hum Reprod 2020; 50:101976. [PMID: 33166706 DOI: 10.1016/j.jogoh.2020.101976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Abstract
Hysteroscopy is known to be the gold standard for evaluation of intrauterine pathologies, pre-menopausal and post-menopausal abnormal uterine bleeding and, in addition to this, it is a crucial examination in the infertility work-up. In-office operative hysteroscopy incorporates the outstanding possibility of seeing and treating an intracavitary pathology in the same examination, eliminating all the risk related to anesthesia and reducing procedure-related costs. By now, performing operative procedures in the office setting is recognized as feasible and safe. Over the last 20 years, many efforts have been made to implement the in-office operative approach worldwide. However, for some women, in-office hysteroscopy is still considered a painful experience, with reported discomfort at different steps of the hysteroscopic procedures. Moreover, uneventful and tedious sensations might be increased by a high level of anxiety for such examination. For this reason, despite the feasibility of the in-office approach, many clinicians are still afraid of provoking pain during the procedure and rather not to perform surgical procedures in the office, postponing the removal of the pathology in the operating room. To date, there is no consensus concerning pain management for in-office hysteroscopy and different approaches, pharmacological and non-pharmacological aids, as well as several procedural tips and tricks are utilized. Our purpose is to provide a feasible practical decalogue for the operator, to supply adequate management of pain during in-office hysteroscopic procedures, performing challenging operations, shrinking discomfort, aiming to upgrade both women's and operator's satisfaction.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | | | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera, Israel
| | - Gaetano Riemma
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Deo N, Khan KS, Mak J, Allotey J, Gonzalez Carreras FJ, Fusari G, Benn J. Virtual reality for acute pain in outpatient hysteroscopy: a randomised controlled trial. BJOG 2020; 128:87-95. [PMID: 32575151 DOI: 10.1111/1471-0528.16377] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of virtual reality as a distraction technique in the management of acute pain and anxiety during outpatient hysteroscopy. DESIGN Parallel group, prospective randomised controlled trial. SETTING UK University Hospital. METHODS Forty consenting, eligible women were randomised to virtual reality intervention (immersive video content as a distraction method) or standard care during outpatient hysteroscopy from August to October 2018. MAIN OUTCOME MEASURES Pain and anxiety outcomes were measured as a numeric rating score (scale 0-10). RESULTS Compared with standard care, women with virtual reality intervention experienced less average pain (score 6.0 versus 3.7, mean difference 2.3, 95% CI 0.61-3.99, P = 0.009) and anxiety (score 5.45 versus 3.3, mean difference 2.15, 95% CI 0.38-3.92, P = 0.02). CONCLUSION Virtual reality was effective in reducing pain and anxiety during outpatient hysteroscopy in a mixed-methods randomised control trial. Its wide potential role in ambulatory gynaecological procedures needs further evaluation. TWEETABLE ABSTRACT Virtual reality can be used as a part of a multimodal strategy to reduce acute pain and anxiety in patients undergoing outpatient hysteroscopy.
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Affiliation(s)
- N Deo
- Imperial College London, London, UK.,Whipps Cross University Hospital, London, UK
| | - K S Khan
- Queen Mary University, London, UK
| | - J Mak
- Queen Mary University, London, UK
| | - J Allotey
- The London School of Medicine and Dentistry, London, UK
| | | | - G Fusari
- Helix Centre, Imperial College London and the Royal College of Art, London, UK
| | - J Benn
- School of Psychology, University of Leeds, Leeds, UK
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Analgesia for Office Hysteroscopy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1034-1047. [DOI: 10.1016/j.jmig.2020.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/18/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022]
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Use of video-based multimedia information to reduce anxiety before office hysteroscopy. Wideochir Inne Tech Maloinwazyjne 2020; 15:329-336. [PMID: 32489494 PMCID: PMC7233155 DOI: 10.5114/wiitm.2019.89378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/03/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Use of multimedia tools has been shown to improve patient comprehension, reduce pre-procedural anxiety, and increase patient satisfaction in various surgical settings. Aim To investigate the impact of video-based multimedia information (MMI) on the anxiety levels of patients undergoing office hysteroscopy (OH). Material and methods All consecutive women aged 18–65 years and scheduled for diagnostic OH were enrolled in this prospective randomized study. Subjects were assigned to receive video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after application of the MMI or written information. All patients underwent a standardized transvaginal hysteroscopy procedure by the same gynecologist. Following the hysteroscopy, patient satisfaction and procedural pain were ranked using a Likert scale and visual analogue scale. Results Fifty-two patients were randomized to receive a video-based MMI, and 52 patients were randomized to receive written information. Post-information STAI-S score was significantly lower in the MMI group than that of the written information group (45.0 ±8.0 vs. 49.4 ±8.4, p < 0.001, 95% CI for the difference: 1.36–7.79). Moreover, the satisfaction rate of the video group was significantly higher than the satisfaction rate of the controls (92.3% vs. 63.5%, p < 0.001). VAS score of procedural pain was similar for the two groups. Conclusions A video-based MMI before OH might be preferred to conventional information methods in order to reduce the pre-procedural anxiety and to increase patients’ satisfaction.
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Gokmen Karasu AF, Aydin S, Ates S, Takmaz T, Comba C. Administration of rectal cytotec versus rectal buscopan before hysteroscopy. MINIM INVASIV THER 2020; 31:94-98. [PMID: 32491923 DOI: 10.1080/13645706.2020.1748059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming.Material and methods: This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30° lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure.Results: Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively (p = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (p=.11). There was no difference with regard to other studied parameters.Summary: HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.
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Affiliation(s)
- Ayse Filiz Gokmen Karasu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Serdar Aydin
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Seda Ates
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Taha Takmaz
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Cihan Comba
- Department of Gynecologic Oncology, Bakirkoy Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Riemma G, Schiattarella A, Colacurci N, Vitale SG, Cianci S, Cianci A, De Franciscis P. Pharmacological and non-pharmacological pain relief for office hysteroscopy: an up-to-date review. Climacteric 2020; 23:376-383. [PMID: 32396751 DOI: 10.1080/13697137.2020.1754388] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In-office hysteroscopy is considered the standard technique for visualization of the uterine cavity and the diagnosis of intrauterine pathologies. Moreover, nowadays, it is possible to treat a vast number of intracavitary diseases in the office, without the need for the inpatient setting. However, in some cases, pain might occur, and this is the most common reason for not completing the procedure. Over the last 20 years, many efforts have been carried out to miniaturize the instrumentation and to improve the techniques in order to avoid discomfort. Nonetheless, hysteroscopy still provokes distress for many patients. For this reason, pharmacological and non-pharmacological treatments for intraoperative and postoperative pain relief have been widely used for in-office hysteroscopy, with different results in various groups of women. The purpose of this review was to analyze the current literature on pharmacological aids (non-steroidal anti inflammatory drugs, cyclooxygenase-2 inhibitors, antispasmodics, local anesthetics, prostaglandins, opioids) and non-pharmacological interventions (transcutaneous electrical nerve stimulation, uterine stretching, uterine pressure, warming of distension medium, hypnosis, music, vocal-local) and to evaluate their impact on the relief from pain experienced during in-office hysteroscopy.
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Affiliation(s)
- G Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - N Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - S G Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - S Cianci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - P De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Abstract
Hysteroscopy and anesthesia have come a long way in the last 150 years. While traditionally performed in the operating theater under general anesthesia, the alternative approach - so-called 'office' hysteroscopy - has gained popularity in recent years. Supporters of this modality cite the 'see and treat' capabilities, avoidance of anesthesia, more rapid turn-around time, and favorable economics as advantages. On the other hand, some question the success rate, capabilities, and patient comfort levels as potential drawbacks. In this article, we review the evidence behind all of these points as well as the requirements for setting up an office hysteroscopy service.
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Affiliation(s)
- J N Mak
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital School, Saint Leonards, NSW, Australia
| | - A Imran
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital School, Saint Leonards, NSW, Australia
| | - S Burnet
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital School, Saint Leonards, NSW, Australia
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20
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Samy A, Nabil H, Abdelhakim AM, Mahy ME, Abdel-Latif AA, Metwally AA. Pain management during diagnostic office hysteroscopy in postmenopausal women: a randomized study. Climacteric 2020; 23:397-403. [PMID: 32299254 DOI: 10.1080/13697137.2020.1742685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: This study aimed to compare efficacy and safety of lidocaine versus tramadol versus placebo in reducing the pain of diagnostic outpatient hysteroscopy (OH) in postmenopausal women.Materials and methods: This randomized double-blinded study included 156 menopausal women who received intrauterine lidocaine infusion or oral tramadol (50 mg) or placebo before diagnostic OH (52 women/group). Primary outcome was pain severity during the procedure using a 10-cm visual analog scale. Secondary outcomes were pain scores 10 and 30 min post procedure, satisfaction level, and ease of cervical entry.Results: Lidocaine had lower pain scores compared to placebo during and 10 min after the procedure (p < 0.001). Tramadol had lower pain scores than placebo during the procedure (p = 0.04), 10 min after the procedure (p = 0.03), and 30 min after the procedure (p = 0.04). Both lidocaine and tramadol resulted in an easier procedure than placebo (p < 0.001 and p = 0.04, respectively). Lidocaine had an easier cervical entry compared to tramadol (p = 0.004). Satisfaction scores in the lidocaine and tramadol groups were significantly higher than in the placebo group (p < 0.001).Conclusions: Lidocaine and tramadol were effective in reducing postmenopausal women-reported pain during and after diagnostic OH. However, lidocaine was better than tramadol in facilitating hysteroscope passage through the cervical canal and the reduction in pain levels with lidocaine was clinically relevant.Trial registration number: NCT03701984.
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Affiliation(s)
- A Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - H Nabil
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A M Abdelhakim
- Department of Histology, Kasr Alainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M E Mahy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A A Abdel-Latif
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A A Metwally
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ghamry NK, Samy A, Abdelhakim AM, Elgebaly A, Ibrahim S, Ahmed AA, Abdelbaky WH, Abdallah KM, Badawy MA, Mohammed AH, Hamza M. Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: A systematic review and network meta-analysis. J Obstet Gynaecol Res 2020; 46:807-827. [PMID: 32088931 DOI: 10.1111/jog.14221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
AIM To identify the highest-ranked pharmacological and nonpharmacological interventions for pain relief during outpatient hysteroscopy. METHODS We conducted an online bibliographic search in different databases from inception till July 2019. We included randomized controlled trials assessing effect of pharmacological and nonpharmacological interventions on pain relief during outpatient hysteroscopy. Our main outcomes were pain scores at different endpoints of the procedure. We applied this network meta-analysis based on the frequentist approach using statistical package 'netmeta' (version 1.0-1) in R. RESULTS The review included 39 randomized controlled trials (Women n = 3964). Misoprostol plus intracervical block anesthesia (mean difference [MD] = -3.32, 95% confidence interval [CI] [-6.06, -0.59]), misoprostol (MD = -1.92, 95% CI [-3.04, -0.81]) and IV analgesia (MD = -2.01, 95% CI [-3.27, -0.25]) were effective in reducing pain during the procedure compared to placebo. Ranking probability showed that misoprostol plus intracervical block anesthesia was the highest ranked pharmacological treatment for pain relief during the procedure (P score = 0.92) followed by misoprostol alone (P score = 0.78), and IV analgesia (P score = 0.76). Regarding nonpharmacological treatments, transcutaneous electrical nerve stimulation (TENS) showed a significant pain reduction compared to placebo (MD = -1.80, 95% CI [-3.31, -0.29]). TENS ranked as the best nonpharmacological treatment (P score = 0.80) followed by CO2 distention (P score = 0.65) and bladder distention (P score = 0.60). CONCLUSION Combination of misoprostol plus local anesthesia appears to be the most effective pharmacological approach for pain reduction during and after outpatient hysteroscopy. Nonpharmacological approaches as TENS and bladder distention showed considerable efficacy but should be further investigated.
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Affiliation(s)
- Nevein K Ghamry
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Safaa Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amal A Ahmed
- Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Waleed H Abdelbaky
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Khaled M Abdallah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Mahmoud A Badawy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Ahmed H Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Mohamed Hamza
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Goswami D, Nisa N, Sharma A, Dadhwal V, Baidya DK, Arora M. Low-Dose Ketamine for Outpatient Hysteroscopy: A Prospective, Randomised, Double-Blind Study. Turk J Anaesthesiol Reanim 2019; 48:134-141. [PMID: 32259145 PMCID: PMC7101193 DOI: 10.5152/tjar.2019.73554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/20/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Outpatient hysteroscopy is often accompanied by pain and discomfort along with frequent occurrence of bradycardia and hypotension. This study aimed to observe if intravenous low-dose ketamine reduces the pain scores along with lowering the incidence of bradycardia and hypotension during hysteroscopy. Methods This prospective, randomised, double-blind trial was conducted in operating rooms in a tertiary care hospital. In this study, we enrolled 72 patients with American Society of Anesthesiologists status I to II undergoing hysteroscopy. We randomised patients into two groups, and both groups received paracervical block. The control group received intravenous pentazocine and promethazine along with saline infusion. The ketamine group received ketamine infusion (0.75 mg kg−1 bolus followed by infusion at the rate of 10 mcg kg−1 min−1). We analysed visual analogue scale (VAS), rescue analgesic consumption, hemodynamic parameters, lowest recorded heart rate, blood pressure, level of sedation, patient’s comfort, surgeon’s satisfaction and nursing staff’s satisfaction. Results Analysis of the data revealed that the pain scores were similar in both the groups (p=0.493, p<0.001). Rescue analgesic was required by 47% patients in control group, compared to only 5.6% patients in ketamine group. Episodes of bradycardia and hypotension were more pronounced in the control group than in the ketamine group [77.4±10.9 vs. 78.4±5.5; 67.6±8 vs. 70.1±6 respectively] (p<0.001). Patient comfort and surgeon’s satisfaction were higher in the ketamine group, but nursing satisfaction was higher in the control group. Disorientation was present in 75% patients in the ketamine group as compared to none in the control group. Conclusion We concluded that low-dose ketamine in day-care hysteroscopy is an effective and safe agent.
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Affiliation(s)
- Devalina Goswami
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Neisevilie Nisa
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anaesthesiology) All India Institute of Medical Sciences, Jodhpur, India
| | - Vatsala Dadhwal
- Department of Obstretics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Arora
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Abstract
The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting.
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Affiliation(s)
- Shilpa Kolhe
- Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK
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Ahmad G, Saluja S, O'Flynn H, Sorrentino A, Leach D, Watson A. Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev 2017; (10):CD007710. [PMID: 35611933 PMCID: PMC6485917 DOI: 10.1002/14651858.cd007710.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hysteroscopy is increasingly performed in an outpatient setting. Pain is the primary reason for abandonment of procedure or incomplete assessment. There is no consensus upon routine use of analgesia during hysteroscopy. OBJECTIVES To assess the effectiveness and safety of pharmacological interventions for pain relief in women undergoing outpatient hysteroscopy, compared with placebo, no treatment or other pharmacological therapies. SEARCH METHODS In September 2016 we searched the Cochrane Gynaecology and Fertility (CGF) Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers (ClinicalTrials.gov and WHO ICTRP), together with reference checking and contact with study authors and experts. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing use of pharmacological interventions with other pharmacological interventions and pharmacological interventions versus placebo or no treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was mean pain score. MAIN RESULTS We included 32 RCTS (3304 participants), of which only 19 reported data suitable for analysis. Most studies were at unclear or high risk of bias in most of the domains assessed. The evidence was low or very low quality, mainly due to risk of bias and imprecision. Baseline pain scores were relatively low in all groups. Analgesic versus placebo or no treatment Local anaesthetics Local anaesthetics reduced mean pain scores during the procedure [(SMD) -0.29, 95% CI -0.39 to -0.19, 10 RCTs, 1496 women, I2 = 80%, low-quality evidence)] and within 30 minutes (SMD 0.50, 95% CI -0.67 to -0.33, 5 RCTs, 545 women, I2 = 43%, low-quality evidence). This translates to a difference of up to 7 mm on a 0-10 cm visual analogue scale (VAS) during the procedure and up to 13 mm within 30 minutes, which is unlikely to be clinically meaningful. There was no clear evidence of a difference between the groups in mean pain scores after > 30 minutes (SMD -0.11, 95% CI -0.30 to 0.07, 4 RCTs, 450 women, I2 = 0%, low-quality evidence), or in rates of vasovagal reactions (OR 0.70, 95% CI 0.43 to 1.13, 8 RCTs, 1309 women, I2 = 66%, very low-quality evidence). There was insufficient evidence to determine whether there was a difference in rates of non-pelvic pain (OR 1.76, 95% CI 0.53 to 5.80, 1 RCT, 99 women, very low-quality evidence). Nonsteroidal anti-inflammatory drugs (NSAIDs) There was insufficient evidence to determine whether there was a difference between the groups in mean pain scores during the procedure (SMD -0.18, 95% CI -0.35 to 0.00, 3 RCTs, 521 women, I2 = 81%, low-quality evidence). Pain scores were lower in the NSAIDs group within 30 minutes (SMD -0.25, 95% CI -0.46 to -0.04, 2 RCTs, 340 women, I2=29%, low-quality evidence) and at over 30 minutes (SMD -0.27, 95% CI -0.49 to -0.05, 2 RCTs, 321 women, I2 = 78%, low-quality evidence). This equates to maximum differences of under 7.5 mm on a 0-10 cm scale, which are unlikely to be clinically significant. One RCT (181 women) reported adverse events: there was insufficient evidence to determine whether there was a difference between the groups in vasovagal reactions (OR 0.76, 95% CI 0.20 to 2.94, very low-quality evidence). For other reported adverse events (non pelvic pain and allergic reactions) evidence was lacking. Opioids One RCT utilised sublingual buprenorphine and one utilised oral tramadol. Data on pain scores during the procedure were unsuitable for pooling due to inconsistency. Tramadol was associated with a benefit of up to 22 mm on a 0-10 cm scale (SMD -0.76, 95% CI -1.10 to -0.42, 1 RCT, 140 women). However, the effect estimate for this outcome for sublingual opioids did not support a benefit from the intervention (SMD 0.08, 95% CI -0.22 to 0.39, 164 women). Compared with placebo, the pain score within 30 minutes of the procedure was reduced in the tramadol group, with a difference of up to 17mm on a 0-10cm scale (SMD -0.57, 95% CI -0.91 to -0.23 , 1 RCT, 140 women, low-quality evidence. There was no clear evidence of a difference between the tramadol and placebo groups at over 30 minutes (SMD -0.17, 95% CI -0.51 to 0.16, 1 RCT, 140 women, low-quality evidence). Nausea and vomiting occurred in 39% of the buprenorphine group, and in none of the placebo group (OR 107.55, 95% CI 6.44 to 1796.46) Analgesic versus any other analgesic Some comparisons did not report pain scores at all time frames of interest, and none reported data on adverse events. One RCT (84 women) compared local intracervical anaesthesia versus combined intracervical and paracervical anaesthesia. Pain scores were higher in the group with local intracervical anaesthesia during the procedure (SMD 4.27, 95% CI 3.49 to 5.06, very low-quality evidence), within 30 minutes (SMD 1.55, 95% CI 1.06 to 2.05, very low-quality evidence) and at more than 30 minutes (SMD 3.47, 95% CI 2.78 to 4.15, very low-quality evidence). This translates to a possible benefit in the combined group of up to 12 mm on a 0-10 cm scale during the procedure. Benefits at longer follow-up were smaller. One RCT compared antispasmodic + NSAID versus local paracervical anaesthesia. Pain scores were lower in the NSAID group than in the local anaesthesia group (during procedure: SMD -1.40, 95% CI -1.90 to -0.91; >30 minutes after procedure: SMD -0.87, 95% CI -1.33 to -0.41; 80 women, very low-quality evidence). This suggests a possible benefit of during the procedure of up to 23 mm on a 0-10 VAS scale and up to 11 mm >30 minutes after the procedure. Other comparisons included local intracervical anaesthesia versus combined intracervical, paracervical and topical anaesthesia, and opioid versus NSAIDs. Findings were inconclusive. AUTHORS' CONCLUSIONS There was no consistent good-quality evidence of a clinically meaningful difference in safety or effectiveness between different types of pain relief compared with each other or with placebo or no treatment in women undergoing outpatient hysteroscopy.
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Affiliation(s)
- Gaity Ahmad
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | - Sushant Saluja
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | - Helena O'Flynn
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | - Alessandra Sorrentino
- Pennine Acute Hospitals NHS TrustDepartment of RadiologyNorth Manchester General HospitalManchesterUKM8 5RB
| | - Daniel Leach
- The Royal Oldham Hospital, Pennine Acute Hospitals NHS TrustRochdale RdOldhamUKOL12JH
| | - Andrew Watson
- Tameside & Glossop Acute Services NHS TrustDepartment of Obstetrics and GynaecologyFountain StreetAshton‐Under‐LyneLancashireUKOL6 9RW
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25
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Opolskiene G, Radzvilaite S, Bartkeviciene D, Ramasauskaite D, Zakareviciene J, Drasutiene G. Pain experience during saline-contrast sonohysterography differs between premenopausal and postmenopausal women. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:267-271. [PMID: 26331948 DOI: 10.1002/jcu.22291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/29/2015] [Accepted: 07/26/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate whether the pain experienced during and after Saline-contrast sonohysterography (SCSH) differs between premenopausal and postmenopausal women. METHODS Sonohysterography was performed on 133 consecutive women because of suspected endometrial pathology. Of these, 34 women were excluded for the following reasons: they had cervical stenosis; they did not complete or return a questionnaire; or tenaculum or cervical dilatators were used during the procedure. All women were asked to fill out a questionnaire to characterize their pain and mark their pain experience on a 100-mm pain visual analog scale. RESULTS Data from the 99 patients included were used for statistical analysis. It showed that sonohysterography was well tolerated overall: 41% of the women did not feel any pain. Postmenopausal women experienced pain during SCSH more often than premenopausal women did: 71% (17/24) compared with 32% (24/75) experienced pain; p < 0.002; the median tolerance on the 100-mm visual analog scale was 43. The character of the pain differed between the two groups of women: postmenopausal women more often felt sharp pain (42%; 10/24), whereas premenopausal women more often felt gnawing and/or crampy pain (21%; 16/75) (p < 0.13). CONCLUSIONS Postmenopausal women were twice as likely to experience pain during SCSH as premenopausal women were. Therefore, postmenopausal women might benefit from analgesia induced prior to the procedure. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:267-271, 2016.
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Affiliation(s)
- Gina Opolskiene
- Vilnius University and the Center of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Clinic, Vilnius, Lithuania
| | - Simona Radzvilaite
- Vilnius University and the Center of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Clinic, Vilnius, Lithuania
| | - Daiva Bartkeviciene
- Vilnius University and the Center of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Clinic, Vilnius, Lithuania
| | - Diana Ramasauskaite
- Vilnius University and the Center of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Clinic, Vilnius, Lithuania
| | - Jolita Zakareviciene
- Vilnius University and the Center of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Clinic, Vilnius, Lithuania
| | - Grazina Drasutiene
- Vilnius University and the Center of Obstetrics and Gynecology, Vilnius University Hospital Santariskiu Clinic, Vilnius, Lithuania
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26
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Capmas P, Pourcelot AG, Giral E, Fedida D, Fernandez H. Office hysteroscopy: A report of 2402 cases. ACTA ACUST UNITED AC 2016; 45:445-50. [DOI: 10.1016/j.jgyn.2016.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 11/15/2022]
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Brix LD, Thillemann TM, Nikolajsen L. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy: A Randomized Study. J Perianesth Nurs 2016; 31:309-16. [PMID: 27444763 DOI: 10.1016/j.jopan.2015.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/09/2015] [Accepted: 09/05/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to compare two anesthetic techniques for postoperative pain after ambulatory operative hysteroscopy. DESIGN A randomized trial. METHODS Women (N = 153) scheduled for ambulatory operative hysteroscopy were assigned to receive either paracervical local anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING Data from 144 patients were available for analysis (LA + S: n = 69; GA: n = 75). There were no significant differences in worst pain intensity between groups in the PACU (P = .13) or after discharge from PACU (P = .40). In group LA + S, fewer patients received treatment with intravenous fentanyl intraoperatively (P < .01) and time until discharge from PACU was shorter (P < .01). More patients in group LA + S experienced vomiting after discharge (P < .05). CONCLUSIONS Local anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy.
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Evaluation of pain in office hysteroscopy with prior analgesic medication: a prospective randomized study. Eur J Obstet Gynecol Reprod Biol 2014; 178:123-7. [DOI: 10.1016/j.ejogrb.2014.04.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/20/2014] [Accepted: 04/22/2014] [Indexed: 11/20/2022]
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Carabias P, Celades-Filella M, Zapardiel I, Alsina-Maqueda A, Genover-Llimona E. Experience and results of office hysteroscopy at a primary hospital. J OBSTET GYNAECOL 2013; 34:54-6. [PMID: 24359051 DOI: 10.3109/01443615.2013.782277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our aim was to analyse, retrospectively, the perioperative outcomes of 3,488 office hysteroscopies. Age, menopausal status, parity, medical indications, use or not of anaesthesia, incidents, presence of pathology in the cavity, endometrial pathology, type of surgery and pain assessment details were collected. The mean age of patients was 52.1 years. The most common medical indication was suspicious ultrasound for endometrial disease, and the most frequent symptom was metrorrhagia. We did not use any type of anaesthesia in 89.5% of patients and we could access the uterine cavity in 99.4% of cases. The complication rate was very low though 12% of patients reported severe pain while performing the test. Although office hysteroscopy in outpatients is fully established and is usually well tolerated, there is a group of patients who could benefit from analgesic treatment prior to the test, to improve their tolerance.
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Affiliation(s)
- P Carabias
- Department of Obstetrics and Gynecology, Mataró Hospital , Barcelona
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30
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Arnau B, Jovell E, Redón S, Canals M, Mir V, Jiménez E. Lidocaine-prilocaine (EMLA®) cream as analgesia in hysteroscopy practice: a prospective, randomized, non-blinded, controlled study. Acta Obstet Gynecol Scand 2013; 92:978-81. [DOI: 10.1111/aogs.12165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Baldomero Arnau
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Esther Jovell
- Epidemiology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Stephanie Redón
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Marta Canals
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Vanessa Mir
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
| | - Elena Jiménez
- Obstetrics and Gynecology Service; Health Consortium of Terrassa; Barcelona; Spain
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